Lecture 1: Intro to psychiatry

Question 1

Mental Disorder (4 pts.)

Answer 1

deviation from normal range of functioning

• not disease-no pathopyhsiology that we know of
• set sufferers apart from their culture
• treatments based on cultural knowledge of the time

Question 2

Modern Era (3 points)

Answer 2

included in scientific advances of 19th and 20th centuries

advances in psychology and development

medicalization of psychiatry

Question 3

Biopsyschosocial model (3 disciplines)

Answer 3

mental disorders involve a web of causation

1. Biological factors- anatomy, genetics, cell bio, neurochemistry
2. pshycological factors- development, coping skills, belief systems
3. social factors- cultural, political, financial, economic

Question 4

Psychiatric interview (3 pts)

Answer 4

interaction with a patient to assess their mental state at a given time and place

includes conversation, inquiry, and observation

approaches “from the outside in”

Question 5

Stages of psychiatric interview (4)

Answer 5

1. inception
2. reconnaissance
3. detailed inquiry
4. conclusion

see slides 8-9

Question 6

elements of hx (9)

Answer 6

chief complaint-what, when, why, why now?

1. hx of present illness (HPI)
2. psychiatric hx
3. familiy medical and psychiatric hx
4. social hx
5. educational hx
6. occupational hx
7. military hx (if applicable)
8. chemical dependence
9. legal

Question 7

chief complaint

Answer 7

chief complaint-what, when, why, why now?

Question 8

hx of present illness (HPI)

Answer 8

duration, precipating factors, specific symptoms, intesity of symptoms, any associated phsycial changes or illnesss (ex. pancreatic cancer and hyperthyroidism causes depression)

Question 9

psychiatric hx

Answer 9

prior episodes of similar symptoms, other types of psychiatris ilness, prior treatments and outcomes

Question 10

family medical and psychiatric hx

Answer 10

familiy medical and psychiatric hx-mental disorders, chemical dependence, medical problems

Question 11

Social hx

Answer 11

family composition, parent’s hx, family live, cultural milieu, signifcant or traumatic events during development

Question 12

educational hx

Answer 12

academic achievement, attitudes toward school, likes/dislikes, socialization in school

Question 13

Occupational hx

Answer 13

1st job, duration of employments, changes in career, significant episodes of disability or unemployment

Question 14

military hx

Answer 14

affiliation, duration, deployments, experience during combat

Question 15

Chemical dependence

Answer 15

use patterns, legal involvements, treatment episodes

Question 16

legal hx

Answer 16

arrests or convictions, lawsuits, bankruptcy

Question 17

Mental status examination

Answer 17

psychiatric equivalent of the physical examination

intended to describe patient’s mental state during the interview

Question 18

elements of mental status exam (8)

Answer 18

1. appearance and behavior
2. relationships to the intreviewer
3. mood and affect
4. cognition and memory
5. language
6. disorder of thought
7. phsyiologic function
8. insight and judgement

Question 19

Appearance and behavior

appearance points
behaviors (4)

Answer 19

describes physcial aspects of patient

should include pertient positives or negatives

detailed but not judgemental

stereotypical behaviors

1. catanoia- minmal or no movement
2. akathesia-difficulty staying still
3. waxy flexibility-action figure posin
4. mannerisms- picking slapping, tapping hands

Question 20

Relation to interviewer

Answer 20

patients attidue, eye contact/body posture/facial expressions

note changes during interview and possible motivations for change

Question 21

Catanonia

Answer 21

minimal or no movement

Question 22

akaethesia

Answer 22

difficulty staying still

Question 23

waxy flexibility

Answer 23

action figure positioning

Question 24

mannerisms

Answer 24

picking, tapping hands, slapping

Question 25

mood and affect mood-def. affect-def. demeanor- def.

Answer 25

mood-sustained emotional quality affect-variable demonstration of patient's internal state demeanor- patient's projection of a specific state, possibly not their true state

Question 26

Mood (6)

Answer 26

sustained emotional state that is frequenly, but not always, associated with certain affect depressed, anxious, irritable, euphoric (extreme elation), labile (rapid mood changes), apathetic

Question 27

affect (7)

Answer 27

moment to moment expression of emotions demonstrate patient's feeling about themselves, others, and situations mood states have typical affects but patients still maintain affective range 1. euthymic- normal mood (not depressed not euphoric) 2. dysphoric- sad, emotionally numb 3. histrionic- rapidly changing, superficial 4. labile- suddenly changing without obvious provocation 5. flat- little expression of emotoin, monotonous 6. angry- signs of hostility 7. incongruent- not consisten with statements or expressed mood

Question 28

Cognition (4)

Answer 28

describes quality of mental functions alertness, orientation, memory, attention, concentration

Question 29

Alertness (4)

Answer 29

fully alert- no impairment coma- non responsive to stimuli stupor- briefly rousable by stimuli torpor- restricted responses to sitmuli twilight- brief sense of confusion and disorientation

Question 30

Derlium

Answer 30

waxing and waning consciousness lack of awareness of surroundings, agitation, hallucinations, restlessness, insomnia, combative, visual illusions, labile affect frequent in ICU and post-op settings caused by metabolic illness, infections, medication, reactions, strokes, many other medical conditions caused by something else-always a result of something*

Question 31

Orientation (4)

Answer 31

person-rarely impaired except in dissociative states time-day, date, month, hear, hour place-building, city, state situation-clinic, hospital, home

Question 32

Memory levels (3)

Answer 32

1. immediate- initial registration by the brain 2. short term-maintained in hippocampus for several minutes 3. long term-memory traces in temporal and parietal lobes

Question 33

memory impairment (2)

Answer 33

1. retrograde amnesia- loss of past memories after severe injury, metabolic illness, intoxication, psychosis, severe anxiety states, dissociative states 2. anterograde- loss of ability to form new memories following head injury or ilness

Question 34

memory disorders (3)

Answer 34

falsification- making up new memories because your old ones suck confabulation- false memories created to dill gaps caused by illness or demential perservation- repeating the same information in response to different inquiries

Question 35

Memory screening

Answer 35

repeat three unrelated words to test immediate recall ask patient to recall words a few minutes later to test short term memory ask about remote events- names of schools, historical events, etc.

Question 36

concentration

Answer 36

ability to focus on a task tests include serial 7 subtrations, spelling, simple words "world" backwards, note distractibility during interview

Question 37

Abstraction

Answer 37

ability to reason in abstract concepts rather than concrete concepts proverbs test-ask what a proverb means to the patient, see if they answer literally humor test-does the person get the joke?

Question 38

Language (3)

Answer 38

note language functions throughout interview flow of speech-fluent, sparse, stilted, over inclusive initiation of speech-spontaneous, latency comprehension-patient's understanding

Question 39

Speech disorders (5)

Answer 39

1. apasia 2. muteness 3. echolalia 4. clang speech 5. word salad ~can be caused by damage to brocha's or werkincke's areas

Question 40

aphasia

Answer 40

difficulty repeating words or phrases

Question 41

muteness

Answer 41

lack of speech

Question 42

parolgia

Answer 42

approximately correct answers

Question 43

echolalia

Answer 43

answers echo questions

Question 44

clang speech

Answer 44

words chosen based on sound rather than meaning

Question 45

word salad

Answer 45

incoherent speech

Question 46

thought processes

Answer 46

inferred by patient's speech and actions assessed throughout interview through observation and inquiry

Question 47

Thought Tempo Abnormalities

Answer 47

1. racing thoughts-rapid thoughts that patient cannot slow voluntarily. frequently accompanied by pressured speech 2. retardation-slow, laborious thoughts with speech latency and sometimes loss of thread

Question 48

Thought Processes (4)

Answer 48

1. goal-directed: patient is able to express coherent thoughts 2. circumstantial: expresses excessive detail and "side trips" but able to reach goal 3. flight of ideas: thoughts skip rapidly between topics with minimal connection to previous thought 4. incoherent: thoughts essentially impossible to follow

Question 49

Thought Content (5)

Answer 49

1. logical-no abnormal thoughts noted 2. paranoid-illogical fears, suspicion 3. ideas of reference- belief that benign stimuli refer to patient specifically ex. ) TV or video game giving personal messages to patient* 4. thought insertion-belief that others implant thoughts in patient 5. thought broadcasting-belief that others can hear the patient's thought

Question 50

Abnormal perceptions (2)

Answer 50

1. illusions- falsely interpreted sensory stimulation | 2. hallucinations- false perception in the absence of sensory stimulation

Question 51

Illusions

Answer 51

shadow passing by, someone in the room, heard someone's voice, heard someone's voice, common in depression/anxiety/extreme stress/delirium

Question 52

Hallucinations (5)

Answer 52

1. auditory-hearing voices, music, etc. 2. visual- simple or complex forms 3. tactile- formication, touching (ex.bugs crawling on them) 4. olfactory and gustatory- smells and tastes 5. somatic- physical symptoms appear to patient as stimulated by persectuion/technology

Question 53

physiologic

Answer 53

sleep functions appetite and weight change sexual changes musculoskeletal changes-agitation, retardation, ambulation

Question 54

Insight and judgment

Answer 54

1. insight- understanding the presence of an ilness and the risks and benefits of treatment 2. judgement- subjective evaluation of the quality and appropriateness of a patient's decision making capacity

Question 55

interview process (5)

Answer 55

1. initiation-greet patient, establish purpose 2. begin with open-ended questions 3. allow free-form answer then begin detailed inquiry 4. focus on clinical and diagnostic symptoms 5. use judgement on when to re-direct interview